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Constipation can be a painful and debilitating affliction that results in the passing of hard, dry bowel motions (stools) that may be infrequent or difficult to pass. The most common causes of constipation include a change in routine, a lack of fibre in the diet, inadequate fluid intake, a lack of exercise and some medications. In some instances constipation can be a symptom of other, more serious illnesses including tumours.If your bout of constipation persists beyond a couple of days don't try to self-medicate with laxatives, seek medical advice immediately.
The symptoms of constipation include:
- Needing to open the bowels less often than usual
- Hard, dry stools that may be painful to pass
- Straining to pass the motion
- Having to sit on the toilet for much longer than usual
- The sensation afterward going to the toilet that you haven’t fully voided
- Bloating and cramp of the abdomen
Constipation can be caused by many different lifestyle factors:
- A change in routine – normal bowel motions depend on the regular and rhythmic contraction of the bowels. This is part of the body’s internal ‘clock’ that can be upset with changes in routine (e.g. Shiftwork or international travel).
- Low fibre diet – as fibre is indigestible, it adds bulk to faeces keeping them moving through the gastrointestinal tract. Of the two types of fibre (soluble and insoluble) it is the soluble fibre that keeps faeces soft and pliable. Soluble fibre comes from sources such as fruit and vegetables. While insoluble fibre – which provides bulk to the faeces – comes from sources such as wholegrain breads and cereals.
- Dehydration – the fibre in faeces absorb water increasing their bulk and forcing them through the body. If insufficient water is consumed, on a high fibre diet, the faeces can become hard and constipation results.
- Exercise – or rather a lack of it. Exercise increases bowel movements by increasing “gastric motility” (movement), a sedentary lifestyle (or being restricted in movement due to a disability or injury) are common causes of constipation.
- Ignoring the urge – when you ignore the urge to go to the toilet the faeces remain in your large bowel. Water is reabsorbed here making the stool harder and more difficult to pass. Regularly ignoring the urge “trains” the body to lower the signalling making you less sensitive to the need to void.
- Some medications – such as narcotics, antidepressants and iron supplements are known to slow bowel movements.
- Pregnancy – the change of certain hormones, decreasing activity coupled with growing pressure of the uterus against the intestines commonly results in constipation during pregnancy.
- Age – older people are more prone to constipation than the young for a variety of reasons such as medication consumption, lowered activity levels, poor muscle tone, etc.
Constipation is sometimes the symptom of an underlying medical problem. This can include
- ‘Slow transit’ – some people naturally void less than others. Such individuals are more likely to become constipated with minor changes in their routine.
- Anal fissure – a tear in the lining of the anus. The person may resist going to the toilet because of the associated of pain.
- Obstruction – the rectum or anus can become partially obstructed (e.g. Haemorrhoids or a rectal prolapse.).
- Rectocoele – the rectum pushes through the weakened rear wall of the vagina when the woman bears down or strains.
- Hernia – an abdominal hernia can reduce intra-abdominal pressure making it more difficult to pass a motion.
- Abdominal or gynaecological surgery – Changing in routine, strange surroundings, post-operative pain, inactivity and medication is a strong cocktail to promote constipation and often requires medical intervention.
- Irritable bowel syndrome (IBS) – characterised by abdominal pain and bloating, IBS suffers alternated between constipation and diarrhoea.
- Tumour – pain (and/or bleeding) while trying to pass a stool can be a symptom of bowel cancer.
- Diseases of the central nervous system – such as MS or stroke increases the susceptibility to constipation.
Chronic constipation can lead to:
- Faecal impaction – the lower bowel and rectum become so packed with faeces that the muscles of the bowels can’t evacuate them.
- Faecal incontinence – an overfull bowel can result in involuntary diarrhoea.
- Haemorrhoids (piles) – constant straining can damage the blood vessels of the rectum.
- Rectal prolapse – the constant straining pushes a section of rectal lining out of the anus.
- Urinary incontinence – Straining weakens pelvic floor muscles lowering control over urinary system (e.g. When coughing or sneezing.).
Treating constipation largely depends on the cause. Treatment may include:
- Removal of the impacted faeces – which may involve use of enemas, stool softeners and a short-term course of laxatives.
- Dietary changes – to increase the amount of fibre in the daily diet. Dieticians generally recommend about 30g of fibre every day and increasing fluid intake.
- Exercise – regular exercise improves bowel motility.
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